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Shahriari M, Dehbozorgi R, Fereidooni-Moghadam M, Moghimi-Sarani E. Family-centered collaborative care for patients with chronic mental illness: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2023; 28:6. [PMID: 36974116 PMCID: PMC10039105 DOI: 10.4103/jrms.jrms_410_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/20/2022] [Accepted: 09/19/2022] [Indexed: 02/25/2023]
Abstract
Background Chronic mental illnesses (CMI) are long lasting and reoccurring and require continuous care as well as an integrated and collaborative approach to organize the care. This study sought to examine whether family centered collaborative care is an acceptable treatment option for individuals with CMI. Materials and Methods From the years 2000 to 2021, ten electronic databases relating to family centered collaborative care for mental illness were searched adopting Preferred Reporting Items for Systematic Reviews and Meta Analysis checklist. Twenty seven relevant articles and a thesis from among 6956 studies retrieved, were assessed their quality appraisal through four standardized tools. The studies were rated as good, moderate, or poor. Studies were calibrated, different opinions were discussed, and extracted data were done. Results Evidence included 11 randomized controlled trials (from 19 articles), one randomized control trial, three mixed methods studies (from 3 articles and 1 thesis), and a qualitative study (from 4 articles). The quality of seven studies was good, 15 were moderate quality, and seven were poor quality. According to moderate to high quality qualitative research, family centered collaborative care was considered an acceptable intervention; though a few studies supported it. Conclusion The findings demonstrated that family involvement in the care of patients with CMI affects no recurrence of the disease, and no re hospitalization of patients with this disorder. As a result, engaging family members in the care process can have a positive impact on the health and well being of these patients.
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Li XY, Liu Q, Chen P, Ruan J, Gong X, Luo D, Zhou Y, Yin C, Wang XQ, Liu L, Yang BX. Predictors of Professional Help-Seeking Intention Toward Depression Among Community-Dwelling Populations: A Structural Equation Modeling Analysis. Front Psychiatry 2022; 13:801231. [PMID: 35280177 PMCID: PMC8907597 DOI: 10.3389/fpsyt.2022.801231] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background A low intention of professional help seeking hinders the effective treatment of depression. The factors are from the perspectives of the social, family, and individual; however, an understanding of how they interact to predict professional help-seeking intention (PHSI) is not clear. Objectives The objectives of the study was to investigate PHSI toward depression in a Chinese community-dwelling population and construct a predictive model of the PHSI to explore the various factors involved. Methods Stratified random sampling and Kish table methods were used to identify 2,000 community residents. Participants completed a series of questionnaires to measure general characteristics, PHSI, professional help-seeking attitude, depression stigma, depression knowledge, family function, and depression symptoms. Analyses included descriptive statistics and Pearson correlation analysis using SPSS 26.0 and a Structural Equation Model using Amos 22.0. Results The score of the PHSI was 14.92 ± 9.574. Professional help-seeking attitude (r = 0.291, p < 0.001) and depression knowledge (r = 0.077, p = 0.002) were positively related to PHSI, while a negative correlation was found between stigma (r = -0.149, p < 0.001) and PHSI. The model of the PHSI indicated a good fit with a CMIN/DF = 2.740 and RESEA = 0.032. The total effect of the influencing factors on the PHSI was listed in the following order: professional help-seeking attitude (0.676) > stigma (-0.143) > depression knowledge (0.088) > depression symptoms (-0.009) > family function (0.005). The total effect of depression knowledge on PHSI included a direct negative effect (Beta = -0.266, p < 0.001) and an indirect positive effect (0.354) through professional help-seeking attitude and stigma. Also, depression knowledge was negatively associated with stigma (Beta = -0.153, p < 0.001). Depression symptoms were negatively associated with family function (Beta = -0.282, p < 0.001), depression knowledge (Beta = -0.252, p < 0.001), and stigma (Beta = -0.102, p < 0.001), indicating that people with less severe depression symptoms had good family function, depression knowledge, and higher stigma. Family function contributed a positive effect on depression knowledge directly (Beta = 0.145, p < 0.001) and a totally positive effect (0.033) on stigma. Conclusion The PHSI toward depression is low among Chinese community residents. Professional help-seeking attitude, depression knowledge, and family functioning were facilitators of PHSI, and stigma and the severity of depression symptoms were barriers to PHSI. This study provides reference for the development of policies and guidelines to promote community residents to actively seek professional mental health help. Future policies can focus on multicollaboration among the government, mental health services, and families to increase the mental health resources, improve family functioning, enhance mental health literacy (MHL) of the public, and reduce depression stigma to ease the burden of this mental health issue.
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Affiliation(s)
- Xin Yi Li
- School of Nursing, Wuhan University, Wuhan, China
| | - Qian Liu
- School of Nursing, Wuhan University, Wuhan, China
| | - Pan Chen
- School of Nursing, Wuhan University, Wuhan, China
| | - Juan Ruan
- Wuhan Mental Health Center, Wuhan, China
| | - Xuan Gong
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dan Luo
- School of Nursing, Wuhan University, Wuhan, China
| | - Yang Zhou
- Wuhan Mental Health Center, Wuhan, China
| | - Cong Yin
- Wuhan Mental Health Center, Wuhan, China
| | | | | | - Bing Xiang Yang
- School of Nursing, Wuhan University, Wuhan, China
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
- Population and Health Research Center, Wuhan University, Wuhan, China
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Liu S, Yang BX, Gong X, Chen J, Liu Z, Zhang J, Wang XQ. Prevalence and Influencing Factors of Depression Self-Management Among Chinese Community Residents: A Cross-Sectional Study. Front Psychiatry 2021; 12:559844. [PMID: 34025464 PMCID: PMC8138045 DOI: 10.3389/fpsyt.2021.559844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to investigate the current status of depression self-management (DSM), and to identify influencing factors of DSM among Chinese community residents. Methods: Stratified random sampling methodology was adopted in this cross-sectional survey. Respondents completed a collection of self-administered questionnaires Results: The majority of participants were female (72.2%), having a mean age of 39 years (SD = 17.3). The total mean score on the DSSM was low (31.63 ± 4.69). Using multiple linear regression analysis, age ranging from 25 to 64 years old (Beta = -0.176, p = 0.008), having personal stigma (Beta = -0.143, p = 0.020) and perceived stigma (Beta = 0.127, p = 0.037), and having a nuclear family structure (Beta = -0.313, p = 0.046), good family function (Beta = 0.278, p < 0.001) and good help-seeking attitude (Beta = 0.159, p = 0.008) were associated with DSSM-knowledge. Older age (≥65 years) (Beta = -0.152, p = 0.034), higher CES-D scores (Beta = -0.162, p = 0.005), having a father with a bachelor's degree or higher level of education (Beta = -0.134, p = 0.047), being female (Beta = 0.147, p = 0.012), indicating a religious preference (Beta = 0.145, p = 0.017) and having good family function (Beta = 0.247, p = 0.001) were significantly associated with DSSM-activities. Conclusions: Reducing stigma related to depression and enhancing help-seeking attitudes may be potential strategies for managing depressive symptoms among Chinese community residents.
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Affiliation(s)
- Shuo Liu
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Bing Xiang Yang
- School of Health Sciences, Wuhan University, Wuhan, China.,Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xuan Gong
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jie Chen
- School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Zhang
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Xiao Qin Wang
- School of Health Sciences, Wuhan University, Wuhan, China
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Petersen JJ, Hartig J, Paulitsch MA, Pagitz M, Mergenthal K, Rauck S, Reif A, Gerlach FM, Gensichen J. Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention. PLoS One 2018; 13:e0202245. [PMID: 30192786 PMCID: PMC6128457 DOI: 10.1371/journal.pone.0202245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/30/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Collaborative care is effective in improving symptoms of patients with depression. The aims of this study were to characterize symptom trajectories in patients with major depression during one year of collaborative care and to explore associations between baseline characteristics and symptom trajectories. METHODS We conducted a cluster-randomized controlled trial in primary care. The collaborative care intervention comprised case management and behavioral activation. We used the Patient Health Questionnaire-9 (PHQ-9) to assess symptom severity as the primary outcome. Statistical analyses comprised latent growth mixture modeling and a hierarchical binary logistic regression model. RESULTS We included 74 practices and 626 patients (310 intervention and 316 control recipients) at baseline. Based on a minimum of 12 measurement points for each intervention recipient, we identified two latent trajectories, which we labeled 'fast improvers' (60.5%) and 'slow improvers' (39.5%). At all measurements after baseline, 'fast improvers' presented higher PHQ mean values than 'slow improvers'. At baseline, 'fast improvers' presented fewer physical conditions, higher health-related quality of life, and had made fewer suicide attempts in their history. CONCLUSIONS A notable proportion of 39.5% of patients improved only 'slowly' and probably needed more intense treatment. The third follow-up in month two could well be a sensible time to adjust treatment to support 'slow improvers'.
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Affiliation(s)
- Juliana J. Petersen
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- * E-mail:
| | - Johannes Hartig
- Department of Educational Quality and Evaluation, German Institute for International Educational Research, Frankfurt am Main, Germany
| | - Michael A. Paulitsch
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Manuel Pagitz
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Sandra Rauck
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Ferdinand M. Gerlach
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Jochen Gensichen
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- Institute of General Practice and Family Medicine, Ludwig-Maximilians University Clinic, Munich, Germany
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Magnée T, de Beurs DP, Kok TY, Verhaak PF. Exploring the feasibility of new Dutch mental health policy within a large primary health care centre: a case study. Fam Pract 2018; 35:186-192. [PMID: 28973383 DOI: 10.1093/fampra/cmx084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A reform of Dutch mental health care aimed to substitute care from specialized care to general practice. Since 1 January 2014, Dutch general practitioners (GPs) are no longer allowed to refer patients without a psychiatric disorder to mental health care. Patients with non-complex psychological problems should be treated within general practice. OBJECTIVE To explore the feasibility of the Dutch mental health policy. METHODS We conducted an observational case study in a primary health care centre in 2014. The health care centre was a convenience sample; the participating GPs reorganized mental health care in line with the upcoming policy, and invited the researchers to monitor their referrals. We assessed how many patients with mental health problems (n = 408) were allocated to policy-concordant treatment. Additionally, 137 patients (33%) completed a follow up assessment on mental health problems 3 months after baseline. RESULTS The majority of the patients were allocated to treatment in line with the policy. Almost half of the patients (42%) were treated in a setting that was exactly policy-concordant, while the other half (47%) was treated in a setting that was even less specialized than was allowed. In general, patients showed improvement after 3 months, regardless of (non) policy-concordant treatment. Attrition rate after 3 months was high, probably due to the practical study design. CONCLUSION There is potential for substitution of mental health care. Since the studied health care centre was specialized in mental health care, further research should explore if similar results can be found in other general practices.
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Affiliation(s)
- Tessa Magnée
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Derek P de Beurs
- Groningen University, Department of General Practice, Groningen, The Netherlands
| | - Thomas Y Kok
- Groningen University, Department of General Practice, Groningen, The Netherlands
| | - Peter F Verhaak
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Groningen University, Department of General Practice, Groningen, The Netherlands
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Stark A, Kaduszkiewicz H, Stein J, Maier W, Heser K, Weyerer S, Werle J, Wiese B, Mamone S, König HH, Bock JO, Riedel-Heller SG, Scherer M. A qualitative study on older primary care patients' perspectives on depression and its treatments - potential barriers to and opportunities for managing depression. BMC FAMILY PRACTICE 2018; 19:2. [PMID: 29295706 PMCID: PMC5751798 DOI: 10.1186/s12875-017-0684-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 12/08/2017] [Indexed: 11/30/2022]
Abstract
Background Depression is one of the most common mental disorders in old age and is associated with various negative health consequences for the affected individual. Studies suggest that patients’ views on depression have an impact on help-seeking behaviour and treatment. It is thus important to investigate the patient’s perspective in order to ascertain optimum management of depression in late life. However, studies on depression and its treatment exploring the perspectives of primary care patients 75 years or older, are rare. Methods Qualitative data was collected in semi-structured interviews with 12 primary care patients 75 years of age or older with symptoms of depression. Data was analysed using qualitative content analysis. Results The study’s results show the multifaceted views on and treatment of depression in primary care patients 75 years of age or older. Some patients seemed well informed about depression and believed in the efficacy of different treatments, such as medications or psychotherapy. However, some individuals had misconceptions about depression and its treatments. Patients mentioned that they would rather avoid talking about depression within their social network, in part of fear of negative reactions. Furthermore, participants believed that other people had little understanding for people with depression. Patients had different views on the relevance of the general practitioner’s (GP) role in treating depression; some patients believed that the GP had little importance in the treatment of depression. Conclusions This study identified positive views of primary care patients 75 years of age or older towards depression as well as views that might hinder optimal treatments. Exemplary implications for an improved management of depression are: educating older adults about depression via age-specific information and having professionals encourage patients in believing that depression is a recognised disorder. Electronic supplementary material The online version of this article (10.1186/s12875-017-0684-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Stark
- Institute of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Medical Faculty, Kiel University, Michaelisstr. 5, 24105, Kiel, Germany.
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Kathrin Heser
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J 5, 68159, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J 5, 68159, Mannheim, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Silke Mamone
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Martin Scherer
- Institute of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Petersen JJ, König J, Paulitsch MA, Mergenthal K, Rauck S, Pagitz M, Schmidt K, Haase L, Gerlach FM, Gensichen J. Long-term effects of a collaborative care intervention on process of care in family practices in Germany: a 24-month follow-up study of a cluster randomized controlled trial. Gen Hosp Psychiatry 2014; 36:570-4. [PMID: 25135191 DOI: 10.1016/j.genhosppsych.2014.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aims of this study were (1) to assess the long-term effects of a collaborative care intervention for patients with depression on process of care outcomes, and (2) to describe whether case management was continued after the end of the original one-year intervention. METHODS This 24-month follow-up of a randomized controlled trial took place 12 months after the end of the 1-year intervention. Data collection occurred by means of self-rating questionnaires and from medical records. We calculated linear mixed and logistic generalized estimating equation models. RESULTS Of the 626 patients included at baseline, 439 (70.1%) participated in this follow-up. Intervention recipients gave higher ratings than control recipients in terms of mean overall Patient Assessment of Chronic Illness Care (PACIC) scores (3.12 vs. 2.86; P = .019), but no difference was found in medication adherence (mean Morisky score 2.59 vs. 2.65, P = .56), prescribed antidepressant medications (60.2% vs. 55.1%; P = .25), visits to the family physician (15.96 vs. 14.46, P = .58) or mental health specialist (3.01 vs. 2.94, P = .94) over the 12 month follow-up period. Case management was continued for 47 (22.5%) selected intervention patients after the original intervention had ended. CONCLUSION At 24 months, intervention and control recipients had different PACIC ratings, but other process of care outcomes did not differ. PRACTICE IMPLICATIONS The main effects of the intervention are apparent at 12 months.
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Affiliation(s)
- Juliana J Petersen
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Mainz, Obere Zahlbacher Str. 69, 55131 Mainz, Germany
| | - Michael A Paulitsch
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Sandra Rauck
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Manuel Pagitz
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Bachstraße 18, 07743 Jena, Germany
| | - Lydia Haase
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Bachstraße 18, 07743 Jena, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Jochen Gensichen
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany; Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Bachstraße 18, 07743 Jena, Germany
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Wernher I, Bjerregaard F, Tinsel I, Bleich C, Boczor S, Kloppe T, Scherer M, Härter M, Niebling W, König HH, Hüll M. Collaborative treatment of late-life depression in primary care (GermanIMPACT): study protocol of a cluster-randomized controlled trial. Trials 2014; 15:351. [PMID: 25195020 PMCID: PMC4247596 DOI: 10.1186/1745-6215-15-351] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/04/2014] [Indexed: 01/18/2023] Open
Abstract
Background Depression is not a normal side effect of aging, however it is one of the most prevalent mental health issues in later life, imposing a tremendous burden on patients, their families, and the healthcare system. We describe the experimental implementation of a collaborative, stepped-care model for the treatment of late-life depression (GermanIMPACT trial) in the German primary care context. GermanIMPACT was developed as an adaptation of a successful and widely used American model. The aim of the study is to evaluate the model’s applicability to the German primary care setting and its cost-effectiveness. Methods/Design The study will be conducted as a cluster-randomized controlled trial comparing the development of depressive symptoms in primary care patients who either receive treatment as usual (control arm) or treatment according to the GermanIMPACT model (intervention arm). In two German cities (Freiburg and Hamburg), a total of 60 general practice offices will be selected and randomized. Each general practice office will be asked to enroll five patients into the trial who are 60 years of age or older and who show moderate depressive symptoms in the scope of a diagnosed depressive episode, recurrent depressive disorder, or dysthymia. General practices in the control arm will provide treatment as usual; general practices in the intervention arm will work closely with a specially trained care manager and a supervising mental health specialist. Evidence-based elements of the treatment plan manual include patient education, identification and integration of positive activities into the daily routine, relapse prevention, and training of problem-solving techniques as needed. The intervention period per patient will be one year. Data will be collected at baseline, 6, and 12 months. Primary outcome is the patient-reported change of depressive symptoms (Patient Health Questionnaire, PHQ-9). Secondary outcomes include measures of quality of life, anxiety, depression-related behavior, problem-solving skills, resilience, and an overall economic evaluation of the program. Discussion The GermanIMPACT trial will provide evidence about the effectiveness, feasibility, and cost-effectiveness of collaborative stepped care in treating late-life depression in German primary care. Positive results will be a first step toward integrating specialized depression care managers into the primary care setting. Trial registration German Clinical Trials Register: DRKS00003589 (September 2012).
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Affiliation(s)
| | - Frederike Bjerregaard
- Division of Psychiatry and Psychotherapy, Psychotherapy and Health Services Research, University Medical Center Freiburg, Hauptstr, 5, 79104 Freiburg, Germany.
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Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525. [PMID: 23076925 DOI: 10.1002/14651858.cd006525.pub2] [Citation(s) in RCA: 456] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES To assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. AUTHORS' CONCLUSIONS Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.
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Affiliation(s)
- Janine Archer
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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